Female Sexual Dysfunction

Abstract

Wide publicity prior to FDA panel meetings and the subsequent approval of flibanserin as the first specific medication for treatment of female sexual desire disorder has created a heightened awareness of women’s sexual concerns. Low libido and complaints about sexual dysfunction are common. They are often non-specific. Patients and providers may be uncomfortable talking about sexuality which makes addressing this important health issue problematic. First, it is useful to understand research models of female sexual function. The classical linear model with progression from stimulation to arousal, plateau, and orgasm is not all that helpful clinically in determining etiology and treatment for our patients. The biopsychosocial model considers physical, psychological, relational, and situational determinants. Focusing on the history (or understanding “her” story) as it relates to these four components will generally uncover the source and inform the treatment for the patient’s complaints. Secondly, considering the patient’s age and physiological status will direct further investigation. DSM V has reclassified female sexual dysfunction into three domains: female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, and female orgasmic disorder. Superimposing this framework on the biopsychosocial model makes identification of the etiology and formulation of a treatment plan for specific complaints considerably easier than most of us fear. Finally, it is important to be sensitive to the patient’s social and medical history. We should not assume that she has a male partner – or any partner at all.